Synthetic cannabinoids are manufactured drugs that are tetrahydrocannabinol (THC) receptor agonists. They are typically applied to dried plant material and smoked.
THC is the primary active ingredient in marijuana (cannabis). There are many chemical families of synthetic cannabinoids, including HU-210, JWH-073, JWH-018, JWH-200, AM-2201, UR-144, and XLR-11; new compounds are being reported regularly. Slang terms for these include "K2" and "spice."
Effects vary greatly depending on the specific cannabinoid, and many of the acute and chronic effects remain unknown. However, stimulation of the THC receptor causes altered mental status with agitation, hallucinations, and psychosis (that may be irreversible). Cardiovascular effects include hypertension, tachycardia, and myocardial infarction. Neurologic effects include seizures and blurred vision. Additional reported effects include vomiting, hyperthermia, rhabdomyolysis, and renal failure.
Symptoms and Signs of Synthetic Cannabinoid Use
Patients taking synthetic cannabinoids may have severe agitation, hallucinations, tachycardia, hypertension, diaphoresis, and seizures.
Diagnosis of Synthetic Cannabinoid Intoxication
Usually a clinical diagnosis
Synthetic cannabinoids are not detected on routine urine screening.
Patients with severe acute intoxication who are severely agitated may need to be evaluated for rhabdomyolysis with blood tests (complete blood count, electrolytes, blood urea nitrogen, creatinine, creatine kinase), urine testing for myoglobinuria, and ECG.
Treatment of Synthetic Cannabinoid Intoxication
IV sedation with benzodiazepines
For patients taking synthetic cannabinoids, the treatment is supportive. IV fluids and sedation with IV benzodiazepines are typically adequate. Patients with hyperthermia, persistent tachycardia or agitation, and elevated serum creatinine should be admitted for further monitoring for rhabdomyolysis and cardiac and renal injury.
